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Continuous electroencephalography in a surgical intensive care unit

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Abstract

Purpose

Our aim was to investigate the prevalence, risk factors, and impact on outcome of nonconvulsive seizures (NCSz), nonconvulsive status epilepticus (NCSE), and periodic epileptiform discharges (PEDs) in surgical intensive care unit (SICU) patients with continuous electroencephalography (cEEG) monitoring.

Methods

This was a retrospective study of SICU patients who underwent cEEG monitoring for altered mental status over a 6-year period. We report the frequency of NCSz (including NCSE) and PEDs on cEEG. The primary outcome was death or severe disability at hospital discharge. Multivariable logistic regression was used to identify whether NCSz (including NCSE) and PEDs were independently associated with poor outcome (death, vegetative state or severe disability).

Results

Of 154 patients, the mean age was 64 ± 14 years old, and 40 % were women. The majority of patients were admitted following abdominal surgery (36 %) and liver transplantation (24 %). Sepsis developed in 100 (65 %) patients. Sixteen percent (n = 24) had NCSz [including 5 % (N = 8) with NCSE], and 29 % (N = 45) had PEDs. All eight patients with NCSE were septic. Clinical seizures prior to cEEG and coma were more common among patients who developed NCSz or NCSE compared to patients without NCSz or NCSE (70 vs. 27 %; p < 0.01; 75 vs. 52 %; p = 0.046 and 63 vs. 34 %; p = 0.09, respectively). NCSzs (including NCSE) were independently associated with poor outcome (20 vs. 3 %, OR 10.4, 95 % CI 1.0–53.7; p = 0.039).

Conclusion

In this retrospective study of SICU patients with cEEG monitoring for altered mental status, NCSz and periodic discharges were frequent and NCSz were independently associated with poor outcome. NCSz were more common when clinical seizures occurred before cEEG.

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Conflicts of interest

None of the authors has any competing interest to declare.

Author information

Authors and Affiliations

  1. Division of Critical Care Neurology, Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY, USA

    Pedro Kurtz, Anna Sophia Wahl & Jan Claassen

  2. Department of Intensive Care Medicine, Clínica São Vicente, Rua João Borges 204, Gavea, Rio de Janeiro, RJ, 22451-100, Brazil

    Pedro Kurtz

  3. Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA

    Nicolas Gaspard & Lawrence J. Hirsch

  4. Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, USA

    Rebecca Marie Bauer

  5. Division of Critical Care, Department of Anesthesiology, Columbia University, College of Physicians and Surgeons, New York, NY, USA

    Hannah Wunsch

  6. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Hannah Wunsch

Authors
  1. Pedro Kurtz
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  2. Nicolas Gaspard
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  3. Anna Sophia Wahl
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  4. Rebecca Marie Bauer
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  5. Lawrence J. Hirsch
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  6. Hannah Wunsch
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  7. Jan Claassen
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Corresponding author

Correspondence to Jan Claassen.

Additional information

Take-home message: Nonconvulsive seizures occur in 16 % of patients admitted to a surgical ICU for post-operative care with altered mental status and are associated with poor outcome at discharge. Risk factors include coma and clinical seizures prior to cEEG monitoring.

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Kurtz, P., Gaspard, N., Wahl, A.S. et al. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Med 40, 228–234 (2014). https://doi.org/10.1007/s00134-013-3149-8

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  • DOI: https://doi.org/10.1007/s00134-013-3149-8

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